| Coquille Valley Health | |
|
2699 N 17th St Coos Bay OR 97420-2134 | |
| (541) 266-3600 | |
| (541) 824-1702 |
| Full Name | Coquille Valley Health |
|---|---|
| Speciality | Orthopaedic Surgery |
| Location | 2699 N 17th St, Coos Bay, Oregon |
| Authorized Official Name and Position | Jeffrey M Lang (CEO) |
| Authorized Official Contact | 5413963101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coquille Valley Health Po Box 374 Coquille OR 97423-0374 Ph: (541) 396-7984 | Coquille Valley Health 2699 N 17th St Coos Bay OR 97420-2134 Ph: (541) 266-3600 |
| NPI Number | 1376374967 |
|---|---|
| Provider Enumeration Date | 08/13/2024 |
| Last Update Date | 09/16/2024 |
| Medicare PECOS PAC ID | 2567902182 |
|---|---|
| Medicare Enrollment ID | O20240910003766 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376374967 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207X00000X | Orthopaedic Surgery | (* (Not Available)) | Primary |
| Provider Name | William B Croson |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1376610915 PECOS PAC ID: 3375557952 Enrollment ID: I20070905000082 |
| Provider Name | Jason S Bell |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1336136647 PECOS PAC ID: 1456424332 Enrollment ID: I20080725000284 |
| Provider Name | Shaun M Hobson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1356388458 PECOS PAC ID: 5890720619 Enrollment ID: I20100818000301 |
| Provider Name | Jeffrey K Bert |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1871540252 PECOS PAC ID: 2264467083 Enrollment ID: I20100818000326 |
| Provider Name | Garry T Vallier |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1376551424 PECOS PAC ID: 5294731832 Enrollment ID: I20121019000068 |
| Provider Name | Laura Franklin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639232978 PECOS PAC ID: 0749425049 Enrollment ID: I20130314000060 |
| Provider Name | Wesley J Johnson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1598758880 PECOS PAC ID: 7113922501 Enrollment ID: I20150825005842 |
| Provider Name | Gabriela Leon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568918563 PECOS PAC ID: 9638456882 Enrollment ID: I20170426001012 |
| Provider Name | Maria Socorro Miel Smith |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1265607295 PECOS PAC ID: 0749583326 Enrollment ID: I20180129000646 |
| Provider Name | Patrick J Edwards |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851351191 PECOS PAC ID: 7416976964 Enrollment ID: I20180214001027 |
| Provider Name | Veronica L Simmonds |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1801004445 PECOS PAC ID: 8022202753 Enrollment ID: I20190301001247 |
| Provider Name | Stephanie Empson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053907006 PECOS PAC ID: 4183038573 Enrollment ID: I20210126001850 |
| Provider Name | Mary Lou Freitag |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962090621 PECOS PAC ID: 5991119141 Enrollment ID: I20210128002356 |
| Provider Name | Kimberly Ann Kyllo-martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649849142 PECOS PAC ID: 5991106841 Enrollment ID: I20210629002256 |
| Provider Name | Heidi Hanst |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174181325 PECOS PAC ID: 8921335787 Enrollment ID: I20220915000982 |
| Provider Name | Samuel Albert Miller |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1881391878 PECOS PAC ID: 4486028099 Enrollment ID: I20230322002128 |
| Provider Name | Jennifer Lynn Dannenbring |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1831893775 PECOS PAC ID: 6305203332 Enrollment ID: I20230607001741 |
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